Alveolar bone grafting in patients with complete clefts: A comparative study between secondary and tertiary bone grafting

• Published in: The Cleft palate-craniofacial journal Vol. 39; no. 1; pp. 18 - 25
• Main Authors: DEMPF, Rupert, TELTZROW, Thomas, KRAMER, Franz-Josef, HAUSAMEN, Jarg-Erich
• Format: Journal Article
• Language: English
• Published: Chapel, Hill, NC American Cleft Palate-Craniofacial Association 2002
• Subjects: Adult; Alveolar Process - diagnostic imaging; Alveoloplasty - adverse effects; Alveoloplasty - methods; Biological and medical sciences; Bone Resorption - etiology; Bone Transplantation - adverse effects; Bone Transplantation - methods; Child; Cleft Palate - diagnostic imaging; Cleft Palate - surgery; Cuspid - pathology; Dental Implants; Dentistry; Dentition, Mixed; Follow-Up Studies; Gingiva - pathology; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Incisor - pathology; Maxillofacial surgery. Dental surgery. Orthodontics; Medical sciences; Non tumoral diseases; Nose Diseases - etiology; Oral Fistula - etiology; Otorhinolaryngology. Stomatology; Periodontal Diseases - etiology; Radiography; Respiratory Tract Fistula - etiology; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tooth Eruption; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Performance evaluation; Human; Radiodiagnosis; Stomatology; Dental arch; Donor site; Treatment efficiency; Maxillofacial; Alveolar bone; Cleft; Exploration; Congenital disease; Radiography; Osteoplasty; Treatment; Malformation; Surgery; ENT disease; Graft; Oral cavity disease; Palate; Technique; Iliac crest; Maxillary disease
• ISSN: 1055-6656; 1545-1569
• DOI: 10.1597/1545-1569(2002)039<0018:ABGIPW>2.0.CO;2

This investigation evaluated the results of alveolar bone grafting in patients with complete clefts, comparing secondary alveolar bone grafting (during the mixed stage of dentition) versus tertiary bone grafting (after completion of the second stage of dentition).
This was a retrospective study. Of 140 osteoplasties, which all were operated according to the same standardized surgical technique, a clinical and roentgenological follow-up investigation was carried out in a collective of 85 osteoplasties. Clinically we searched for oronasal fistulae, assessed the periodontal status, determined the extent of the gingival attachment in the area of the osteoplasty, and searched for vertical growth disturbances in the area of the osteoplasty. Roentgenologically the height of the alveolar bone in the former clefted area was ascertained.
Records were obtained from a clinical and radiological study of the Department of Oral and Maxillofacial Surgery of the Medical University of Hannover (Germany).
All patients were operated with the same standardized surgical method. The osteoplastic bridging of the alveolar cleft was performed via a vestibular gingival marginal incision and exclusively by grafting of cancellous bone from the iliac crest.
The best results of alveolar bone grafting in cases of secondary osteoplasty were obtained when the lateral incisor or canine had grown into the transplant and had led to a functional stress of the transplanted bone. Approximately good results were to be found in tertiary osteoplasty when the transplanted bone had been stressed functionally through a dental implant. Comparing the secondary with the tertiary osteoplasty, there was a trend of lower resorption in secondary osteoplasty.
Secondary osteoplasty should represent an integral component of any concept for the comprehensive treatment of patients with cleft lip and palate.